Supragingival and Subgingival Irrigation.pptx

Supragingival and Subgingival Irrigation

1. Supragingival and Subgingival Irrigation

2. ORAL IRRIGATION DEVICES Supragingival irrigation Subgingival irrigation Oral irrigation has been shown to Disrupt and detoxify subgingival plaque Can be useful in delivering antimicrobial agents into periodontal pockets

3. This is used as an adjuct to scaling and root planing and also to improve oral health. Used in TWO distinct ways, in Therapy phase and in Maintenance phase Professionally delivered irrigation Home or self-applied irrigation

4. Professionally delivered irrigation ( chairside ) Mechanical debridement of deep pockets is incomplete and does not completely remove residual subgingival biofilm and also calculus. With antimicrobial irrigation, bacteria left behind could be eradicated and better results after scaling and root planing is obtained. 3 factors for efficacy, 1. Penetration 2. Concentration 3. Duration

5. Penetration – Agent must be able to penetrate to the base of pocket to reach periodontal infection. Concentration – Agent must be of sufficient concentration to be bacteriostatic or bactericidal. Duration – Agent must maintain concentration for sufficient duration to be effective against biofilm . To penetrate the pocket a blunt cannula using hand syringe or mechanized device placed 1-3 mm into the pocket and penetration ranges from 70-95%. 2 types- side port and end port cannulas are used, side port has lowest ejection pressure and also presence of calculus impair penetration to deep pockets

6. Rubber tip used by patient for subgingival irrigation Cannula tip used by dentist for subgingival irrigation

7. Concentrations of agents used may not be effective on cells in biofilm . Effectiveness was reduced or inactivated when in contact with blood components in pocket, flushing action of GCF because of outward flow and wash out of agents and half life of agents used subgingivally is 13mts. Agents used are CHX, tetracycline, stannous fluoride and povidone -iodine.

8. Home (self-applied) irrigation Dentist and his patient engineer developed in 1960s. Trials failed due to limited ability to reduce plaque, but evidence shown reduction in gingivitis, bleeding on probing and periodontal pathogens. Latest studies that home irrigation stimulates host modulation effect

9. Mechanism of action – direct application of a pulsed or steady stream of water or other solution. Pulsation provides for a compression and decompression phase which clears bacteria from pocket. Oral irrigator with 1200 pulsations per minute on a medium to high pressure setting (50-90psi). This creates 2 zones of hydrokinetic activity- Impact Zone , where solution contacts the area and Flushing Zone , where solution reaches to subgingival sulcus and outcome is subgingival penetration

10. 2 tips - Standard jet tip - Soft, site specific subgingival tip Other tips are available but does not show subsequent results. Irrigation with standard tip is called supragingival irrigation- point of delivery is at or coronal to gingival margin resulting in penetration of solution to subgingival sulcus by 50%. Used for full mouth irrigation

11. Irrigation with Soft, site specific tip is called Subgingival Irrigation – placement of tip is beneath gingival margin. Used for localized irrigation of specific site – deep pocket, furcation , implant or crown and bridge.

12. Safety Concerns about safety – soft tissue damage, penetration of bacteria into the pocket but no scientific evidence has been proved. Consider patients overall medical and health status. Consultation with patients Physician to assess risk and clinical judgement .

13. Clinical Outcomes Reduction in plaque, calculus, gingivitis, bleeding on probing and probing depth reduction, reduction in periodontal pathogens and inflammatory mediators. Can be used as periodontal maintenance, pts with orthodontic appliances, maxillary fixation, crown and bridge, implants and diabetes. Compliance is one of the major consideration.

14. CHX dilutions shown effective in clinical trials Conc. Water CHX 0.02% 5 parts 1 part 0.04% 2 parts 1 part 0.06% 1 part 1 part based on CHX of 0.12%

15. Oral irrigation covers 2 treatment modalities for the prevention of periodontal disease. Professional irrigation – limited value. Self applied irrigation is accepted by majority of patients.